1447. Retrospective Study Comparing the Characteristics of NTM Vertebral Osteomyelitis and Tuberculous Vertebral Osteomyelitis
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Abstract Background Nontuberculous mycobacteria (NTM) species rarely cause vertebral osteomyelitis (VO). The clinical characteristics and radiological findings of NTM VO are not well described since the number of cases are limited. Here we present the clinical characteristics of culture positive NTM VO, compared to those of tuberculous (TB) VO. Methods We performed a retrospective, multicenter study at 5 hospitals. Patients with radiologic findings consistent with VO, and positive NTM or TB cultures on biopsy were included. Demographic characteristics and symptoms were collected, along with laboratory, radiologic, and pathologic findings. Results Nineteen patients with NTM VO and 105 patients with TB VO were included. M. intracellulare (52.6%) and M. abscessus (26.3%) were the most common NTM pathogens. The mean age of patients was significantly older in the NTM VO group (68.0 vs. 58.5 years, P = .01). Previous steroid or immunosuppressant use was more frequent in the NTM VO group (21.1% vs. 2.9%, P = .01; 15.8% vs. 2.9%, P = .046, respectively), as was a history of vertebral surgery (47.4% vs. 13.3%, P < .001). Symptoms and laboratory findings were similar between the 2 groups, although the proportion of patients with positive interferon-gamma release assays (IGRA) was significantly higher in the TB VO group (14.3% vs. 86.4%, P < .001). Radiologic findings were also similar, with lumbar involvement being the most common (57.9% and 44.8%, respectively). Chronic granulomatous inflammation was more frequently seen in TB VO patients (33.3% vs. 64.0%, P = .04), while inflammation alone was more common in NTM VO. Although there was no significant difference in survival after 1 year, survival at last follow-up (median, 24 months) was significantly lower in the NTM VO group (75.0% vs. 98.8%, P = .02). Conclusion NTM VO should be considered in older patients with a history of immunosuppression or previous vertebral surgery. The pathologic findings and radiologic findings of NTM VO were similar to that of TB VO. Granulomatous inflammation and positive IGRA tests were more common in TB than NTM VO. Disclosures All Authors: No reported disclosures.Keywords:
Vertebral Osteomyelitis
Nontuberculous Mycobacteria
Vertebral Osteomyelitis
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Vertebra
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Hematogenous pyogenic vertebral osteomyelitis (VO) is a rare and often fatal complication of osteomyelitis that can affect individuals with underlying medical conditions, hospital-acquired infections, and intravenous (IV) drug abuse. Pyogenic vertebral osteomyelitis can present with generalized back pain, pyrexia, motor weakness, and neurologic deficits. The enigmatic presentation of this condition often results in delays in diagnosis and an increase in mortality. This case report aims to bring awareness to complications of hematogenous pyogenic vertebral osteomyelitis as well as highlight the need for further studies in order to establish standardized treatment. In our report, we depict a case of complicated pyogenic VO that required pharmacological and surgical intervention.
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Intravenous drug
Presentation (obstetrics)
Epidural abscess
Intravenous antibiotics
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Bone disease
Bone Infection
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Osteomyelitis of the spine is a well‐recognized delayed manifestation of septicemia but has not been recognized as a complication of total parenteral nutrition. We report five cases of spinal osteomyelitis that were clinically recognized 1 to 13 months after total parenteral nutrition catheter‐induced septicemia. Radiographic evidence of osteomyelitis was seen in all five patients. In three patients, culture of bony aspirates was positive for the same organism as from the blood. In one case, the diagnosis was established by histology, and in one the diagnosis was based on radiographic and radionuclide evidence of osteomyelitis. The organism responsible was Staphylococcus aureus in two cases, Candida albicans in another two cases and C tropicalis in one case. The septic episode that preceded osteomyelitis was treated with systemic antibiotics and catheter removal in four patients, and antibiotics without catheter removal in one patient. Nevertheless, osteomyelitis occurred, requiring bracing or operative debridement as well as prolonged antibiotic therapy. Spinal osteomyelitis may occur as a delayed manifestation of total parenteral nutrition catheter‐induced septicemia. Prompt and effective treatment of septicemia is indicated but may not always be sufficient. Clinical suspicion is the key to the correct and early diagnosis of osteomyelitis and therefore to adequate treatment. ( Journal of Parenteral and Enteral Nutrition 19: 291—295, 1995)
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Vertebral osteomyelitis (also termed spinal osteomyelitis, spondylodiskitis, or disk-space infection) is a bone infection and inflammation, considered as a type of osteomyelitis concentrated in the spinal region. Cases of this condition are so rare, because only 2-4% of all bone infections are attributed to the disease. It is considered uncommon, with an incidence of 1 case per 100,000-250,000 population per year. However, some reviews suggest that the incidence of spinal infections is now increasing. We present the case of a 49 year old male who presented with symptoms of Pott’s spine, but eventually diagnosed with Staphylococcus aureus vertebral osteomyelitis of D7 & D8 with secondary pathological fracture and epidural abscesses, decompression with stabilization done.
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Vertebral osteomyelitis is a rare but serious infectious disease that causes inflammation and destruction of the spinal vertebrae. Prompt diagnosis and treatment are essential to avoid adverse outcomes. This article reviews risk factors for vertebral osteomyelitis, disease mechanisms, signs and symptoms, and diagnostic criteria. Medical imaging techniques for vertebral osteomyelitis are a main focus, and treatment, prognosis, and possible complications also are discussed. Finally, the special case of pediatric patients with vertebral osteomyelitis is presented.
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This report describes a patient with AIDS who presented with vertebral osteomyelitis secondary to Mycobacterium avium complex (MAC). We briefly discuss the literature regarding MAC osteomyelitis in patients with and without AIDS. This patient's course demonstrates the need for a microbiological diagnosis in order to optimally manage osteomyelitis in patients with AIDS.
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Vertebral Osteomyelitis
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